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Understand the Effects of Understaffing in Nursing Homes

Nursing shortages have been a known challenge in the industry for decades. Despite having a significant staffing shortage in the early 2000’s, the Great Recession produced an influx of registered nurses provided the largest increase in 40 years[1]. Despite an improving economy, the intensive demand and acuity of care required for nursing staff continue to be a deterrent, as well as additional opportunities for increased wages and employment elsewhere outside of the “floor staff” line of work. As well, there will be a continued slippage of RNs exiting the workforce as they have been since 2015 and continues today[2].

The nursing home industry is complex in nature. Numerous demands compete for the resources of the operators of the nursing homes, as administrators and front-line staff continue to address the needs of an aging population that increases year over year from Baby Boomers who continue to need short-term or long-term care. It is projected by 2030, approximately 20% of the population or 70 million individuals will require some form of elderly care whether it is the short-term, long-term, or in-home care.[3]

For those who are currently in the healthcare field in a managerial or human resource capacity can truly understand the gravity of high turnover experiencing in the field. With the increase of more facilities, particularly those specialized in different needs, the shortages will continue to increase. Thus, the anticipated demand plus the anticipated and continued investment by healthcare entities into new facilities or specialized services will continue to exacerbate the strain on resources.

Examining how to address the shortages in the long term, the most viable solution would be the inclusion of academics, clinical, and those in healthcare policy to consider alternative means to attract more individuals to the field, as well as provide them a stronger economic outlook for the future. The limitations of the staffing shortages are further accentuated by lack of clinical personnel willing to provide college instruction which is necessary for providing quality of care to each segment of the population. The crushing burden of student loan debt is an added deterrent into additional entrants in the nursing field which should be taken into consideration.

In the short term, the industry should consider two ways to deter the strain of services. One is to re-examine the healthcare disparities that exist within the diverse population of Americans today. Acute illnesses often change to chronic ailments which develops to chronic health problems resulting in an increased need of services. Increasing healthcare literacy and education in affected demographics will provide some long relief from extended need of services and bounce back rates to the hospitals. Second, involves reverse engineering the causes of turnover which often comes from burnout, long hours, economic wages, and psychological demands on nursing staff.

Turnover leads to reduced effectiveness of desired quality of care outcomes, a decrease in productivity and staffing levels, and an increase of potential medical errors or deficiencies involved with wound care, medication errors, and interrupted lapses of concentration required to perform the essential functions of the job. According to the 2016 National Healthcare Retention and RN Staffing Report, the financial cost of turnover may range from $37,700 - $58,400. If a facility loses an average of two nurses a month, the anticipated loss can range from $904,800 - $1.4 million directly and indirectly.

Such numbers underscore the need to invest in resources directly or indirectly in the proper retention of staff or examine alternative methods. Several methods could include the following:

· Examine alternative staffing measures to alleviate the pressure of short staffing – The indirect value of adding nurses through staffing agencies or through part time models can provide cash savings, improved flexibility and family time which is one of the chief reasons for nursing burnout.

· Extend training and follow ups – Employee surveys are a good means to examine if nurses are receiving adequate training; however, most managers and HR personnel do not provide constructive solutions thus repeating the same potential pitfalls that continue to drive turnover rates. Following up with nurses and aides on the floor several weeks after orientation provides an opportunity to address potential learning gaps and outline what other training measures are necessary.

· Empowerment – In the current age of self-realization and the desire to feel wanted, nurses would benefit from being empowered to make more decisions. Providing leadership training to nurses who are not in management or time management skills can improve decision-making which could lead to more operational efficiency on the floor.

· Emotional intelligence – The unknown psychological burden nurses carry is high when considering the needs of the patient and the demands of family members who are not particularly knowledgeable in the needs of the resident or the operations of the facility. Thus, more training in emotional intelligence with administrators and front-line staff may help provide some relief and outline better solutions that could satisfy the needs of their internal stakeholders (staff) as well as the external stakeholders (patients/family members).

A continued conversation is necessary to help solve the healthcare crisis that exists in elderly care. It will take a concentrated effort to address the long- and short-term concerns of staffing and the overall needs of care to provide an effort to close the gap relating to staffing shortages and improving overall quality of care outcomes. Seeking the services of an outside consultant or specialist that can provide value added services would justify any investments made for the sake of professional development which can provide a competitive advantage over competitors that can be more realized than other investments that may not provide the desired financial revenue.

Dr. Terrence Duncan has over fifteen years of enterprise risk management experience ranging in matters from human resources, worker’s compensation, and strategic leadreship. He has published two books on leadership and personal development, as well as published in several academic and international journals and book chapters. Dr. Duncan has spoken in esteemed academic conferences and specializes in providing consulting services to businesses in risk management, human resources, strategic leadership, and change management. For additional information for services offered or questions on the content of this article, please contact More information is available on


[1] Staiger, D.O., Auerbach, D.I., & Buerhaus, P.I. (2012). Registered nurse labor supply and the recession - Are we in a bubble? The New England Journal of Medicine, 366(16), 1463-1465.

[2] Snavely, T. (2016). A brief economic analysis of the looming nursing shortage in the United States. Nursing Economics, 34(2), 98-100.

[3] Spetz, J., Trupin, L., Bates, T., and Coffman, J.M. (2015). Future demand for long-term care workers will be influenced by demographic and utilization changes. Health Affairs, 34(6), 936 – 945.


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